Search Decisions

Decision Text

AF | PDBR | CY2013 | PD2013 00066
Original file (PD2013 00066.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: xx         CASE: PD1300066
BRANCH OF SERVICE: NAVY  BOARD DATE: 20130604
Date of SEPARATION: 20030426


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PO3/E-4 (EN3/Engineman) medically separated for a bilateral ankle condition. He has a long history of bilateral ankle pain, and has had multiple surgeries on each ankle. The bilateral ankle condition could not be adequately rehabilitated to meet the physical requirements of his Rating or satisfy physical fitness standards. He was placed on limited duty and underwent a Medical Evaluation Board (MEB). The bilateral ankle condition was found medically unacceptable, and was forwarded to the Physical Evaluation Board (PEB) IAW SECNAVINST 1850.4E. No other conditions were submitted by the MEB. The PEB found the bilateral ankle condition unfitting, and rated each ankle 10% for a combined disability rating of 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Th ree other conditions ( listed in the r ating c omparison chart below ) were adjudicated as C ategory III ( not separately unfitting , and not contribut ing to the unfitting condition ) . The CI made no appeals, and was medically separated.


CI’s CONTENTION: The CI elaborated no specific contention in his application.


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The ratings for the unfitting bilateral ankle conditions are addressed below. The Category III conditions: obstructive sleep apnea, asthma, mediastinal and right hilar adenopathy were not contended, and therefore not within the DoDI 6040.44 defined purview of the Board. These and other contentions remain eligible for future consideration by the Board for Correction of Naval Records.

IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.


RATING COMPARISON :

Navy IPEB – dated 20030124
 VA* – (1 mo. Pre -Separation)
Condition
 Code Rating Condition Code Rating Exam
Failed Resection, Subtalar Coalition, Bilaterally S/P Bilaterally Subtalar Fusions 5272-5003 10% Subtalar Fusion, Left Ankle 5271 10%** 20030307
5272-5003 10% Subtalar Fusion, Right Ankle 5271 10%** 20030307
Obstructive Sleep Apnea (OSA) Category III OSA 6847 50% 20030307
Asthma Category III Asthma 6602 10% 20030307
Mediastinal & Right Hilar Adenopathy Category III Mediastinal & Right Hilar Adenopathy 6820 NSC 20030307
No Additional MEB/PEB Entries
 Other x 4 20030307
Combined: 20%
 Combined: 70%
* Derived from VA Rating Decision (VA RD ) 200 30326 (most proximate to date of separation (DOS) )
** VARD 20070323 raised left & right subtalar ankle fusion ratings to 20% each based on a C&P 20070214 retroeffective to the DOS


ANALYSIS SUMMARY:

Bilateral Ankle Condition. The CI has a long history of bilateral ankle pain. Initially he was treated with anti-inflammatories, subtalar injections, physical therapy, and other conservative measures. In December 1999, he had bilateral ankle surgery at Portsmouth Naval Hospital in Virginia, but this failed to relieve his pain. In September 2001, he underwent subtalar arthrodesis of the left ankle. Nine months later, he had the same procedure performed on the right ankle. Postoperatively, it was determined that he would not be able to fully perform his required military duties and an MEB was initiated. His MEB physical examination (PE) was on 13 September 2002, 3 months after right ankle surgery. On exam, there was limited ankle motion, mostly eversion and inversion. The examiner stated that dorsiflexion was full. Measurement of ankle range-of-motion (ROM) revealed 30 degrees plantar flexion, and 10 degrees dorsiflexion. Neurovascular status was intact. Motor testing was normal and there was no evidence of instability. In March 2003, the CI had a VA Compensation and Pension exam. On exam, both ankles seemed well aligned. They were generally puffy and diffusely enlarged, but not hot. Ankle ROM testing revealed about 10-20 degrees of flexion and extension bilaterally. The ROM evaluations which the Board weighed in arriving at its rating recommendation are summarized in the chart below.

Ankle ROM
 MEB ~ 7 mos. Pre-Sep
(20020913)
 VA C&P ~ 1 mo. Pre-Sep
(20030307)
Left Right Left Right
Dorsiflexion (20⁰ is normal)
 10⁰ 10⁰ 10-20⁰ 10-20⁰
Plantar Flexion (45⁰ is normal)
 30⁰ 30⁰ 10-20⁰ 10-20⁰
Comment
 “dorsiflexion is full” “walks fairly normally for his size”

The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The Navy PEB and the VA chose different coding options for the ankle condition. The PEB used VASRD code 5272-5003 (ankylosis, with degenerative arthritis). The VA coded the ankle condition as 5271 (ankle, limited motion of). Based on the evidence in the treatment record, and IAW VASRD §4.71a, the Board determined that the CI’s bilateral ankle surgery had left his ankles in good weight-bearing position. Furthermore, with regard to ankle ROM, he had moderate limitation of motion. The record did not show sufficient evidence to characterize his limited ankle motion as “marked.”

After due deliberation, the Board determined that a separation disability rating of 10% for each ankle was warranted. The Board tried to find a path to a rating higher than 10%, using other codes which could be applied to the ankle condition. The other VASRD codes that were considered did not result in a higher rating, since the record did not show sufficient evidence of a disabling ankle abnormality which would justify a rating higher than 10%. Considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board unanimously recommends no change in the PEB adjudication for the bilateral ankle condition.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the bilateral ankle condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.


RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION
 VASRD CODE RATING
Failed Resection, Subtalar Coalition, Bilaterally S/P Bilateral Subtalar Fusions 5272-5003 10%
5272-5003 10%
COMBINED (w/ BLF)
 20%


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130208, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record





         xx
         President
         Physical Disability Board of Review


 MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS

Ref: (a) DoDI 6040.44
(b) CORB ltr dtd 5 Nov 13

In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their respective forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:
- former USMC
- former USN
- former USN
- former USN


                                                      xx
                                                     Assistant General Counsel
                                                      (Manpower & Reserve Affairs)


Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-02659

    Original file (PD-2013-02659.rtf) Auto-classification: Denied

    She was placed on limited duty twice and referred for a Medical Evaluation Board (MEB). The rating for the unfitting ankle condition is addressed below; no additional conditions are within the DoDI 6040.44 defined purview of the Board. The Board concluded therefore that this condition could not be recommended for additional disability rating.

  • AF | PDBR | CY2012 | PD2012-00697

    Original file (PD2012-00697.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW Code 5271 Rating 20% NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200697 SEPARATION DATE: 20031130 BOARD DATE: 20130111 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was a National Guard SPC/E‐4 (31K10/Combat Signaler), medically separated for “chronic right ankle pain with loss of subtalar joint motion secondary to fracture of the talus (26 Jul 02),...

  • AF | PDBR | CY2012 | PD2012 01674

    Original file (PD2012 01674.rtf) Auto-classification: Denied

    He continued to have pain in his ankle joint, and on 11 April 2000 the CI underwent a right ankle talar surgical procedure(bone graft from knee) with some improvement; however, he was unable to run. Radiographs of the right ankle in May 2003, a year after separation demonstrated surgical hardware devices were in place, and no fractures or acute abnormality noted.At the MEB narrative summary (NARSUM) evaluation on 12December 2001, 3 months prior to separation, physical examination revealed a...

  • AF | PDBR | CY2014 | PD-2014-01364

    Original file (PD-2014-01364.rtf) Auto-classification: Approved

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of theVeterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation. Right Ankle Condition . At the MEB examination on 23 November 2005, 4 months prior to separation, the CI reported constant right ankle pain worsened by weight bearing activities or twisting of the ankle treated with...

  • AF | PDBR | CY2012 | PD2012 00941

    Original file (PD2012 00941.rtf) Auto-classification: Approved

    The PEB adjudicated “pain left ankle and right wrist” as a single unfitting condition, rated 0% and “fusion of distal interphalangeal joint of the left non-dominant ring finger” as unfitting, rated 0%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). Pre-Separation) ConditionCodeRatingConditionCodeRatingExam Pain Left (this should be right)Ankle and Right Wrist5099-50030%Right Ankle Fracture5010-527110%*19990626Right Wrist, Residuals, status post (s/p)...

  • AF | PDBR | CY2012 | PD2012-01639

    Original file (PD2012-01639.pdf) Auto-classification: Denied

    The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. Right Ankle Condition. Other PEB Conditions.

  • AF | PDBR | CY2012 | PD2012 01552

    Original file (PD2012 01552.rtf) Auto-classification: Denied

    The PEB adjudicated the bilateral post-traumatic arthrosis of the ankles condition rating each ankle 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The remaining conditions were determined to be not unfitting and determined to be Category 2; conditions that contribute to the unfitting condition but are not separately ratable. The most serious of these issue being my ankle issues, both Left and Right ankles, for which I had surgery while on active duty....

  • AF | PDBR | CY2009 | PD2009-00481

    Original file (PD2009-00481.docx) Auto-classification: Denied

    All evidence considered, the Board unanimously recommends a rating of 20% for the chronic, painful left foot and ankle condition. Other PEB Conditions . Mr. XXXX’s records not be corrected to reflect a change in either his characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board.

  • AF | PDBR | CY2013 | PD-2013-02629

    Original file (PD-2013-02629.rtf) Auto-classification: Approved

    Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Bilateral Ankle Pain5099-500310%Stress Reaction Right Ankle52710%*20040804Stress Reaction Left Ankle52720%*20040804Other x0 (Not in Scope)Other x2 Rating: 10%Combined: 0%Derived from VA Rating Decision (VARD) dated 20050114 (most proximate to date of separation)VARD dated 20060913 increased rating to 10% for each ankle effective 20060623 ANALYSIS SUMMARY :The FPEB diagnosed the combined the bilateral ankle pain as a single unfitting...

  • AF | PDBR | CY2012 | PD2012-01227

    Original file (PD2012-01227.pdf) Auto-classification: Denied

    The MEB forwarded no other conditions for Physical Evaluation Board (PEB) adjudication. Pre-Sep Right Left -10* 25 2 35 Comment *“Lacks 10⁰ to 0/Neutral DF” Left 10 25 Right 12 35 L ankle w/ mild generalized tenderness; Drawer sign (-); mild valgus-varus laxity; strength 3-4/5; Neurovascular intact; 1+ foot & ankle edema; TTP Left 0-20 0-45 Right NE Normal gait; no painful motion, edema, instability or weakness; no flat feet; no limited function of standing or walking; has left...